Tim J. Edwards

Healthcare IT, Process Improvement, Making IT Easier

Tim J. Edwards - Healthcare IT, Process Improvement, Making IT Easier

HIMSS 2015 Wrap-up

HIMSS 2015 has come to a close. This is the 6th HIMSS I’ve attend in-person over the past 11 years and here are some observations from my time at McCormick Place.

The Best of HIMSS15

  1. Without doubt, the highlight of the show was hearing President George W. Bush share his stories. I couldn’t help but be impressed by the open, honest, and frank way he speaks. I truly felt inspired by his commitment to life, family, democracy, and his country. Add to that, the ability to laugh at himself and the word interoperability was just priceless.
  2. Education Sessions – The choices this year seemed to be the best yet, offering a wide-range of options for needs both small and large institutions. I always leave this conference feeling I’ve grown both as an IT professional and in my knowledge and understanding of healthcare. So many sessions seemed to be perfectly in-line with my fundamental belief that technology should improve process, but first you must understand the process so technology can be applied properly. I heard outstanding examples of clinician/technician engagements that produced wonderful solutions. It’s great to know there are people out there who are pushing the boundaries and always remembering why we are in this business, to improve care.
  3. Meeting/Tweeting – I met many amazing IT professionals this week, most are wrestling with the same challenges and together we could share stories, commiserate and give each other support. Geographic borders and organizational conflicts melted away to the point were two people were just sharing stories and offering advice. While this normally happens at HIMSS, this year the social media aspect was broader then ever before and I had the good fortune of meeting even more in the virtual space (@timjedwards).
  4. City of Chicago – A big thank you to the City of Chicago for your hospitality and for providing such an interesting backdrop for our conference. Your downtown life is a wonder to behold and the food has been amazing.

The Less-Then-Best of HIMSS15

  1. Size Matters – I love the fact that this conference is so big from a pride standpoint, but the logistics of little things was trying at times.
    1. Too much time was spent commuting, to and from the conference as well as from room to room. McCormick is a great place, but perhaps the education sessions can be grouped more by themes or topics so one is not forced to go from S406 to W375 and back. (Many of you know exactly what I mean on that one)
    2. The logistics of getting to and from the airport were a challenge as well. I actually opted to skip the Thursday morning sessions after seeing the baggage check lines on Wednesday and realizing all the airport shuttles were long-booked. I really feel for the presenters who drew the last-day slots and I promise to listen to your sessions virtually.
    3. Food – In many sessions, the topic of personal health and responsible decisions were central to the discussions. However, our food options at the show were not so healthy. We need both more healthy food options and just more food locations in general.
  2. Vendors – I know many attendees love the exhibit area and are anxious to engage with vendors on their products and services. I, however, am not. I am here to learn and meet kindred spirits in the world’s largest support group. I do not appreciate the aggressive sales approach I felt when walking through the exhibit area and the constant vendor “nagging” I received via the HIMSS15 app. I wish there was a way to indicate “I am not responsible for purchases so you don’t want to waste your time on me.” Maybe our badges could be a different color so they don’t see me as green.

Now that HIMSS15 is behind us, it’s time to get back to work with a renewed sense of what is possible and a heightened responsibility to do IT right! Thanks for listening and I’ll see you at HIMSS16 in Vegas!

-Tim (@timjedwards)

HIMSS 2015 Day 3

Day 3 at HIMSS15 opens with a minor issue, my laptop did not charge at all last night! I’m now forced to do my note taking the new-fashioned way, on a touch-sensitive keypad…yikes.

Session 1: Healthy Living, Connected Devices, & Wearables Roundtable Discussion

The opening discussion was about how the entertainment industry knows how to produce shows people like and we should aim for the same goals in designing health-monitoring/enhancing systems. Access, cost, and quality are the new standards for efforts. In the consumer’s mind quality means engagement, or their willingness to want to come back again and again. Quality of care will be measured by consumer engagement.

We are moving away from an episodic model to a preventative model through technology. A typical person will spend a few hours with their doctor during a given year, but spend countless hours engaged in health decisions on a daily basis. The care model is moving from reactive to proactive with the provider as facilitator of care.

Today there is a bit of a disconnect in what consumers are trying to accomplish and the effectiveness of current programs like weight loss or smoking cessation. You will see a number of users who download an app, use it for a week, and then disappear. Adoption is one thing, utilization is another. It’s not about how many devices are purchased it’s how they are used.

The call to free the data from devices and proprietary platforms was echoed again. Data freedom will empower consumers to be their own best advocate.

Roundtable Discussion

  • Challenges, rewards, penalties, all help. How do we tap into human nature and reach pervasive change?
  • The simplicity of the interface is crucial ease of use and integration.
  • The biggest behavior changes happen when these tools become social, that seems to be the most powerful way to make change.

This topic has been echoed at many sessions this week and It’s very apparent that we know what we want to do, but just don’t yet know how to do it, how do we make a Facebook for healthcare? Can we?

Session 2: ONC Consumer eHealth Action Plan & Advancing the Blue Button

Lanna Moriarty, Director, Office of Consumer eHealth, ONC

ONC is definitely on the path of encouraging a culture of change that supports person-centered care. They are but one of the MANY voices I heard throughout this conference and it stands in stark contrast to the message from 10 years ago when efficiency meant seeing more patients. I fairness, the focus was on removing the non value-added processes such as redundant data forms to allow the clinician to really focus on the person in the room.

The Blue Button initiative began in 2011. “It is a symbol and a movement that you can get your health information here.” The goal is to “free the data” and make it easy for you to get access to health information. I have to admit, I have not heard of this effort and would have liked a bit more background would have been helpful, but I found their website during the talk: http://healthit.gov/patients-families/your-health-data

The Blue Button lets you go online and download your health records so you can use them to improve your health, have more control over your personal health information and your family’s healthcare.

Session 2 Second Topic: Overview: Engaging Consumers Through HealthIT

Jodi Daniel, JD Director of Policy ONC,

When we started, the discussion was all about the doctors and not about the patients. Getting information from the patients was designed to help the doctor make better decisions.

Now the focus is on the patient, or rather the person at the center of their care. I do like the notion of a person versus the connotations associated with the word patient. ONC has been working on policies to promote personal engagement, interoperability, and a common clinical data set for data exchange.

2017 goal is the ability to share data over a “Common Clinical Data Set” and that products can respond to API requests for data. This approach is taking a page directly out of the IT developer’s playbook, give me access and I’ll make some magic! 

Random Thought: They say batteries are to us what fire was to the caveman. 5 minutes at HIMSS15 proves it.

Session 3: Improving Clinical Communications and Workflow via Smartphones

Ed Fisher and Dr. Allen Hsiano from Yale New Haven Health system walked us through an outstanding program they implemented bringing smartphones into both their adult and pediatric emergency departments. The talk included the why, the how, and that results including lessons learned. Very impressive.

The need for better communication was established early-on with examples like bad overhead paging, ineffective group communication channels, HIPAA concerns, etc. They stared with a wish list and wanted to consolidate all communication to a single device. It is insane to be caring a pager, cell phone, possibly a tablet, or any number of other devices all at the same time.

The wish list stared with texting, VOIP, a staff directory, and access to patient data. Further user discussions illustrated the need for real-time staff presence (who’s here), alerts, EMR integration, directed alerting, and EMR updates. Other considerations include security, both physical and logical, network connectivity (Wi-Fi and cellular), charging, assigning, MDM, etc.

The solution was not a BYOD effort, but rather a purchase of devices that stay in the EDs. They also made sure no PHI is ever stored on the devices themselves.

Lessons Learned

  • The Big Bang approach (rolling it out widely from the start) worked well, the tool was less effective when not used by everyone
  • Strong nursing a physician leadership was needed to make the work
  • Triple check Wi-Fi coverage – we had to learn how the Apple iPhone worked on Wi-Fi. You don’t what a physician in the middle of a call have it dropped.
  • Having signs or cases on the devices help to show the patients you are not on your personal device.
  • Centralized storage and accountability for devices are key – They use badge scanners to open the cabinet and us video surveillance
  • Quickly adding functionalities helps adoption – We you ask for something and it is delivered quickly, you become very committed to the process.

New Functionality

  • Eye chart on every device – When assessing an eye injury, they no longer have to take the patient to the chart for an assessment.
  • Common Peripheral Vessels chart has helped with IVs and blood draws – patients like the nurse checking things like this
  • Durable Medical Equipment (DME) Billing and Scanning – using the built-in camera for scanning – helps with supply management
  • Medical photos – with the images being integrated with the EMR and not stored on local device. Before this, our two main options were to take images with a regular camera and use cards that could be easily lost or stolen or to take images with your own personal phone.

Results Survey – How did we impact care in the EDs? The survey results show significant improvement in communication, reduction of noise, and the improvement of patient care.

In the future, they are looking a dynamic alarms, dynamic assignments: sending message to a role like attending on call versus an individual name, which changes every day. Next steps include a full enterprise rollout and continued functionality expansion.

Community-based physicians need to communicate with the EDs and that is vital going forward. We are looking to spilt the phone with two different numbers so you can have both personal and professional function on the same device.

This is a very interesting project and drastically illustrates how technology can improve process. Ironically, but using a technology solution they have actually drastically reduced their potential for PHI breeches.

Session 4: Innovation in Health Care Delivery: Accelerating with New High Impact Practices

Roy Rosin, Chief Innovation Officer, Penn Medicine

First, having an innovation officer is clearly a sign of a forward-thinking organization.

Before you can start with innovation, you must first build a foundation, getting the appropriate approvals and establishing a sand-box for innovation and rapid development.

To achieve innovation, you have to go into the environment and see what your customers see and do what your customers do. Actual behavior and stated behavior are not the same, you have to see it. There are contextual reasons why people do the things they do.

There is real power in story telling, tell me the story of what you need, then design solutions that answer the actual need. We almost always solve the wrong problem.

An innovation technique is not to ask why, but rather ask 5 “so whats”.

The dialog would be: Ok, tell me the story. What would be good about that? So, why is that better?

Innovation can leverage techniques like fake front ends, putting something out there that does not exist to see if there is any demand. If so, build it. You can see this in online retail at times when an item is “out-of-stock.” The retailers may be doing research to see if a product will actually be purchased before investing.

There are also fake back ends. When IBM was working on speech to text, instead of building a massive system, they tested the process by bringing in users and having a person in the back room fake the process by typing what the tester was saying. This illustrated the utility of the tool before spending the money in development.

We should flip the process from design, build, sell to sell first, making sure people want it before building.

This was an outstanding session that has me thinking in different ways and considering how I can facilitate more innovation on my team.

Keynote: President George W. Bush

Before President Bush took the stage, the announcement came out, “No recordings, no photography, and no note-taking during the presentation.” That caused quite a stir in a room filled with IT people.

After the opening drama, President George W. Bush took the stage and participated in an hour-long discussion on a range of topics from his presidency.

Highlights Included

  • His opening joke: One day you are president and the next you’re not. It’s a bit of a shock.
  • A recount of the events and his thoughts during the 9/11 crisis
  • A discussion about his brother Jeb and his “likely” candidacy for the Presidency: Do you want Bush/Clinton/Bush/Obama/Bush or Bush/Clinton/Bush/Obama/Clinton?
  • An incredible story about President Putin dissing his dog Barney and the lessons one can learn about a man’s character.
  • A similar story about Tony Blair that stood in stark contrast to Putin
  • The work he has been doing to combat AIDS and Cervical Cancer in Africa and how protecting life is essential to our interests.
  • And a consistent theme of what his family means to him and how his father continues to inspire him.

During 9/11, the Japanese Prime Minister called and pledged to stand shoulder-to-shoulder with us to promote freedom in the world. President Bush could not help but to think about his father who enlisted early to fight the Japanese after Pearl Harbor and how that enemy has become a close ally because they chose freedom and democracy.

President Bush was humble, appropriately self-deprecating, funny, and incredibly inspiring. I consider myself fortunate to have had the opportunity to hear him speak today. Thank you HIMSS!

HIMSS 2015 Day 2

Welcome to HIMSS15 Day 2

Being a process improvement guy, I set-out to improve my process for attending HIMSS today by getting coffee BEFORE the 45 minute Starbucks line. Feeling good with my early success, I decided to improve the shuttle process by hailing a cab. Let’s just say, I’m one-for-two today…

Opening Keynote: Bruce Broussard, President and Chief Executive Officer, Humana

I arrived late to the session and missed the video that everyone was discussing. I’ll need to see if that is available somewhere, but I was there to hear the main point of the discussion: changing the conversation.

We are making progress, but our perspective is inhibiting progress. The problem is in this room, we don’t need another technology, we need to change perspective and be bold leaders in changing healthcare.

-Bruce Broussard

Insurance companies need to make it easier: preauthorization, paying, approving care, and asking how can we help people improve their health

Providers: The conversation needs to change from a volume-based model to a value-based model. It’s the quality of care and improved outcomes that need to matter.

Tech companies need to shift their focus to look at information as a shared asset, not as a proprietary asset. Interoperability is a good place to start because we can all benefit from greater data sharing.

Humana’s Goal: The communities we serve will be 20% healthier by 2020 because we make it easy for people to achieve their best health.

In the end, this was a very good presentation with a lot of great thoughts; I just hope our culture can shift to look at the value of care versus the number of visits.

HIMSS Statistics

HIMSS15 is big, but just to add emphasis to the word big, they have posted a number of statistics for us to see when walking from location to location.

  • The exhibit space is 1.3 million square feet or around 22 football fields
  • This conference will book 90 hotels this week, accounting for over 90,000 rooms (you’re welcome Chicago).

Personally, I can vouch for the size of this place because each day I’ve moved literally from one end of the conference center to the other at least twice.

Session 1: HIT Alone Isn’t Enough: Humanizing Patient Engagement

While the majority of my focus is on internally facing systems, we are all in their business to ultimately improve the patient experience and outcomes.

The session will focus on building a statewide patient portal. Patients are more satisfied when they have access to their medical information online and they are more empowered in their own care.

Kentucky is a tobacco state and has the highest cancer rate in the country and frankly, “Our health rankings in Kentucky suck.” They are working to move the needle, but “Y’all move your needles faster!” All joking aside, the challenges in Kentucky are real and they have set good goals and are making progress.

Kentucky has a successful state-based HIE and they have reduced their uninsured rate from over 20% to under 10%. Their PHR is called myHealthNow. Their efforts provide a good reminder to place the patients at the center of efforts, involving and aligning with stakeholders, have a plan and collaborate whenever possible. It is interesting to me how the truly successful programs all seem to follow this similar pattern. Our stakeholders and customers must be an integral part of system design/configuration/deployment for it to truly transformative.

Lunch

Lunch at HIMSS15 has been cancelled due to overwhelming lines and the promise of Girodano’s for dinner tonight. I did have the opportunity to catch-up with a vendor who I’ve worked with quite a bit over the past four years, once again proving the value of face-to-face interactions.

Session 2: Mobile, Digital & Connected Health: A Status Update

Great start: This will be a bit more patient facing and leading edge other sessions. Three is a large appetite for virtual care. My expectation level just went up.

5 Key Aspects of Personal Connected Health

  • feedback loops
  • motivational engagement
  • Integrated into everyday life to succeed
  • improved outcomes correlated with engagement
  • Interoperability wand frictionless technology are critical

The ultimate goal is to integrate care into the day-to-day lives of our patients at Connect Health, your healthcare should follow you and be top of mind.

Two value propositions have been proven by their efforts.

  • Just-in-time care – make much better decisions for your care based on feedback when it is needed.
  • Improved self-care – an unexpected outcome of the study, but something that will be the savior for healthcare going forward. The concept is, a more informed patient who receives feedback would do a better job of self-care.

Feedback Loop – If I can collect something objectively about you and send it back, it becomes a source of truth, stays top-of-mind and can lead to quantifiable goals. Collection needs to be automated and seamless and not rely on people because when we self report, we say what we think the doctor wants to hear or how we want to be perceived. Wearables fade quickly into the background on their own. There needs to be a bigger context for wearing and reporting your data.

To be effective, feedback needs to be combined with motivational contextual content to keep the patient engaged. Content can be supplied by involving doctors, nurses, and nutritionists in this care. All of this is fed into an algorithm to supply the correct feedback based on available data targeted to the needs of the particular patient. “We are headed to deliberately chosen equalizer motif with motivators like games and we can target the best modifier to improve your health.”

Examples:

Congestive heart monitoring – This was their first effort and success was determined by measuring readmissions. The process has the patients providing daily uploads of their vitals and coaching based on what is being seen. Feedback is provided and this type of just-in-time care has drastically reduced readmissions.

They have implemented similar programs for blood pressure and diabetes monitoring. Eventually this type of monitoring will be integrated with smart phones, but for now we provide devices. With this data, a provider monitoring a dashboard can reach into the lives of their patients like never before and can provide feedback. For patient engagement, mobile is a game-changer.

Because we are collecting this data and uploading it, we can tell your level of engagement and can tell how much you interact with the clinician and the engagement measure always correlate to the clinical outcomes.

Mobile Concepts

  • Make it about everyday life – Integrating daily weather reports with reminders about sunscreen. They were excited to get the weather report, we were excited about the sunscreen message. This is the new wave of healthcare messaging
  • Text 2 Move – About type 2 diabetes and improving activities without human intervention. The tool measured a patient’s willingness to be active (first data point) with their actual activity level via wearable, factored in  weather, and utilized location-based data. All combined in an algorithm to sends customized messages to the patient and producing significant results

Consumer may want lots of choice, but providers want information and efficiency. As a provider, why do I want everyone’s step count or thousands of normal readings in my EHR? For a busy doctor, the ability to use email would save more lives than a FitBit.

There will probably not be a healthcare version of snapchat or other viral applications, health information just doesn’t work that way.

Putting data in the system is putting the cart before the horse. Our ability to collect data outpaces our ability to analyze it, standards help future-proof our systems, standards help reduce risk. “Standards are the distilled wisdom of distributed failures.” What do you call failing quickly, recovering, and starting again in Silicon Valley? Innovation. What do you call it in healthcare? Malpractice.

4 Trends driving interoperability

  1. Commoditization of hardware
  2. Changing distribution of risk in healthcare
  3. Increased interest of governments
  4. Emerging technologies to disintermediate proprietary and siloed software systems (Disintermediate – (verb) to attempt to do away with intermediary entities between two primary market forces; to eliminate the middleman)

We are now starting to see a critical mass of devices and the need for standards is taking hold, driving us forward. Healthcare is assuming more risks with these devices and they are forcing change. The next wave of adaptation will be driven by providers to target populations and drive their business more dramatically.

Just to kick things up a bit more, they quoted from the updated Cluetrain Manifesto in regard to web pages versus apps:

  • We all love our shiny apps, even when they’re sealed as tight as a Moon base. But put all the closed apps in the world together and you have a pile of apps.
  • Put all the Web pages together and you have a new world.
  • Web pages are about connecting. Apps are about control.
  • In the Kingdom of Apps, we are users, not makers.
  • Every new page makes the Web bigger. Every new link makes the Web richer.
  • Every new app gives us something else to do on the bus.

-From: http://cluetrain.com/newclues/

“Web pages empower, apps control. I’m not saying don’t build apps, but we are building an ecosystem, let the data out and do something an a broader perspective.”

Brilliant.

Session 3: Preparing for a New Level of HIPAA Enforcement

HIPAA enforcement to date – 24 OCR enforcement actions, where money has changed hands. Of those, 23 have been settlements and 1 has been a formal enforcement action. The one entity did “everything wrong.”

Congress pushed for more monetary penalties with HI-TECH, but has not happened yet.

Total settlements to date: $26,133,100 with the average settlement of $947,022 and the fines seem tied to the size of the entity versus the egregious nature of the violations. The government does not seem to be trying to put anyone out of business with these actions.

Breaches have been the driving force, reported by patients or employees. Compliance reviews are driving now things now.

While the odds may be in your favor that you will not have a breach or an audit, they are going down year after year.

The major take away from this session is the need to focus on your risk analysis and encryption process. There is zero tolerance for unencrypted devices in today’s climate.

Summary

Day 2 was very busy and I covered many McCormick miles again today. Tomorrow brings a marathon of educations sessions and is capped off with a keynote by President George W. Bush.

HIMSS 2015 Day 1

HIMSS15

Welcome to HIMSS15 day one in Chicago’s McCormick Place. I’m told they are expecting over 40,000 attendees at this year’s HIMSS Conference and can’t help but be impressed by how much this event has grown since my first in 2004. Not only are there more attendees, the organization of the conference, quality of the offerings and the overall production value of the presentations is quite impressive. With that, here are my highlights from day 1.

Opening Keynote Address

The musical group who opened the show was fantastic and brought a much-needed wake-up jolt to this event.

Paul Kleeberg’s opening address focused on the goal to get the right information available to the right people in the right format at the right time to make the right medical decisions and in demonstrating the value of HIT through intuitive interfaces, understandable views/dashboards, and engaging patients in their own care

Keynote Address: Alex Gourlay, EVP of Walgreens Boots Alliance and President of Walgreens

Mr. Gourlay’s talk centered around three objectives:

  • How to become patient and customer-led culture
  • Encouraging innovation
  • Becoming a strategic partnerships

In citing innovation, Mr. Gourlay Innovation explained how Walgreens opened their first store in 1901 in Chicago and have always placed the patient always at the center of everything. He spoke of the roll of the community pharmacy where the pharmacist knows their patients and is positioned to deliver better care because they are part of the community. This is an Intriguing thought in the age of volume visits.

How will Walgreens continue to play and active role in community health? Through their 8,200 drug stores, but that will not be enough. The customer is really starting to change and is more empowered than ever before. That is where technology enters the picture. Things like the Walgreens mobile app have become a key focus in moving the company forward.

Walgreens refill application has cut the 5-minute phone refill to 30 seconds. Adding the ability to chat with the pharmacist has been very beneficial and timely for customers. Today, they conduct over 9,000 chats per day.

Next, they are working on a new Apple Watch app in May which will feature medication reminders to address the problems caused by patients missing their doses. Walgreens also gives points to their customers for a healthy lifestyle, walking, monitoring blood pressure etc. They’ve launched awards for wearable technology and are integrating with others such as WebMD Digital Health Advisor platform to expand the capabilities and adoption.

The goal of this integration is to be frictionless or effortless for the patient/customer.

My biggest take-away from this session is, I should really download the Walgreens App!

Session 1: There’s an App for That

The presentation centered around Non-HIPAA Regulated Medical Data; Information from the individual, medical devices, trackables, flowing back and forth into the cloud. Not regulated by HIPAA/HI-TECH, but may be FTC or FCC.

As an example of the dangers, the talk mentioned the risks of geo-location and personal security causing unintended consequences for personal safety. I found this especially intriguing as I was turning off the many geo-location features within the HIMSS Mobile App. Just because we can know your location doesn’t mean we should.

The best take-away from this talk is the role of intended use. It is the intended use of a device determines if it is a medical device. A flashlight used to light a path is not a medical device, but the same light used to look in a mouth is and subject to regulation. This is an ever-evolving space that will be critical going forward.

Session 2: Harnessing the Science of Behavior Change in Digital Health

Paul D’Alessandro opened the talk by discussing the “routine” nature of landing jets on an aircraft carrier and how this amazing act is routine due to every detail being choreographed and planned.

While behavioral change is difficult, our behaviors HAVE changed in the past decade; just look at the prevalence of mobile phones and how we are dependent on them now.

The concepts of friends and family shaping and risk aversion (not missing out on an award) drove the change.

Incentives work, but its not just about economic incentives. We need to think about incentives in different forms. Achieving some guru status may be huge for millennials and we need to tap into what really motivates people to change.

The short-term satisfaction can be summed up with this quote: I value a cheeseburger today more than I value the risk of a cardiac arrest tomorrow.

The part of this presentation that has me really thinking was the assertion that we are not designing healthcare applications correctly. When you look at someone’s phone or desktop, they are all configured to reflect the personal preferences of the user or to maximize their efficiencies. When it comes to healthcare applications, they all look the same. This is not personal.

In the digital domain, we should have the same things as a continuing care community – social circles, activities, routines to remove stress, guides to help me keep fit, help me keep my mind sharp, provide me a new way to engage in social circles.

Session 3: Internet of (Insecure) Things: Medical Devices

Scott Ervin (@scotterven) and Beau Woods (@beauwoods)

From this talk, I found two very important take-aways in regard to medical devices.

Malicious intent is not a prerequisite for adverse patient outcomes. Get out of the mindset that people would not want to hack a device; a breach can happen accidentally and does not require malicious intent.

There was also mention of an “Empathy Deficit Disorder” in IT today. This one really struck a chord with me as I believe this is the root of many of our IT struggles. At the end of the day, we should be working with customers/patients to improve their experience through empathy and understanding. It’s more work, but it really is the only way to make it right.

As usual, HIMSS15 is off to a good start with both provocative presentations and a wealth of things to do and see. On a side note, I had the good fortune of meeting several “kindred spirits” at HIMSS today and it reminded me why I attend this conference in-person versus exclusively online. No matter how cool the technology, there will never be a replacement for face-to-face interactions.

The Evolution of IT Expectations

During my morning scan if trade newsletters, a blog post in TechRepublic addressing the changing view of IT departments caught my eye:

Today, most of these employees are on at least their third or fourth new PC at home. A lot of them have smartphones. Some of them even carry their own personal laptops or tablets. Millions of them have personal email through Gmail or Yahoo Mail and love the seamless online ordering at Amazon.com. A few of the really advanced ones are even managing their personal files across multiple devices with cloud services like Dropbox.

So when IT tries to deploy them outdated computers, or enforces limits on the size of email attachments, or makes web applications that are nearly impossible to use, or doesn’t allow employees to check the corporate calendar from their personal smartphones, then these employees no longer see the IT department as an enabler. They view it as a roadblock to progress.

I would take this observation a bit further. Recently, while sitting in my parent’s house, I saw 4 smart phones, 2 iPads, a laptop, and a desktop all in use with a group of about 10 people. The users ranged in age from teens to senior citizens and while the kids seemed to be most comfortable, even the senior citizens were discussing updating their Facebook statuses.

We have all seen or experienced the IT roadblock at one time or another. You have likely said or heard any or all of these:

  • “Why can’t I use my iPhone to view my labs?”
  • “What do you mean our email system does not support Android?”
  • “Windows XP! Are you kidding me!?!?”

The answers from IT departments are always the same.

  • “There are security risks.”
  • “We have budget constraints and limited resources.”
  • Or my favorite, “We don’t know how to support those.”

The bottom line is, we must find a way to embrace the new technologies. The user of today is one who spends significant portions of their day viewing and sending content on mobile devices, monitoring the activities of their friends, and generally commenting on their experiences. These are the users who can spread the word of good service just as quickly as bad. By embracing new technologies, healthcare organizations can improve the patient experience and start to alter the way people view healthcare delivery.

Today’s healthcare consumer is not the same as yesterday’s and it is time for us to realize change has happened before our eyes.

Want Best Practices? Look Outside of Healthcare

My boss and I were invited to the National Institute for Health (NIH) last week to share our experience in developing physician and patient portals. After spending most of the day meeting with various NIH staff members and their Medical Executive Committee, I came away with a renewed sense of energy and excitement for what we do; using IT to improve hospital operations. Like HIMSS a couple of weeks ago, my time with the NIH has shown there is a growing group of dedicated healthcare professionals who see the way to reform is through the use of HIT. What has also become apparent is the way to reform is not going to be found by looking within healthcare.

All too often you hear these questions: What are other healthcare institutions like us doing in this space? How are the leading healthcare organizations dealing with this problem? Who is best-in-class in this and how can we learn from them? These are all excellent questions, but they need to be applied to those outside of healthcare. Benchmarking each other will produce incremental improvements and not the kind of reform needed today. Healthcare needs to recognize what customers expect in their online experience and step-up.

Do you want to streamline patient appointment scheduling? Look at the airline industry. Through the web, I can search available flights by cost, time, or flight duration, select the flight that best meets my needs, schedule and pay for the flight and even pick my seat (unless you are on Southwest…).  That is best-in-class thinking and it is what the general public is used to for online interactions. Is making a clinic visit really that much more complicated then flying a plane?

You want to improve the laboratory testing process? Take a look at the pizza industry. On the web, I can select the exact pizza I want, size, toppings, crust, follow the creation of the pizza, and know exactly where it is in the creation process. What if you applied that process to the lab? Allow physicians to order the exact test they need, schedule when it is going to happen, and provide transparent access to the entire process so they can know exactly when those results are going to be available.

You want to improve you patient check-in process? Look again at the airline industry. Airlines allow check-in up to 24 hours prior to the flight. This eases congestion at the gate, moves people through the airport with greater efficiency, reduces the staff required to process passengers, and generally improves the entire user experience. What if you took this process and used it in healthcare? Patients could check-in prior to their appointment, electronically review information and sign any required forms, and electronically process any co-pays or required fees. Patients could receive a “boarding pass” that indicates they are ready to go and be allowed to focus on the business of their care versus the logistics of being a patient. Think of the savings in staff hours, space utilization (patients are not spending minutes/hours completing forms in the waiting rooms), and the reduction in no-shows.

The bottom line; there are others out there who are doing the same processes used in healthcare who have found ways to do it better. Find those examples, study them, and adapt processes based on that new learning.

Yes, there are barriers to change and there will always be barriers to change. What we can no longer afford to do is keep our heads in the sand as an industry or only accept what others like us are doing.

The world has changed, the bar has been raised, and it is time for us to jump.

You Can’t Send Medical Records Over the Internet

Anyone who has spent time advocating for Healthcare IT has no doubt heard some variation of, “You can’t send medical records over the Internet.” There seems to be a prevalent belief that electronic communications are somehow less secure than other forms of communication and that using tools like the Internet is inherently dangerous. Let’s take a look at the processes used for four types of communication (phone, mail, fax, and web) and compare how they stack-up against the measure of protecting health information (PHI).

US Mail – The old tried and true method of sending PHI has always been the US Mail. You drop that letter in the box with the utter 100% assurance that it will reach the intended recipient each and every time and never be misrouted or intercepted. Really? You take PHI, print it on a piece of paper, stick it in an envelope, seal it with spit, drop it into the hands of the Federal Government and hope it gets to where it’s going.

Here’s what you don’t know. You don’t know who handles the PHI in transit. Did the PHI actually reach the intended address and was the address correct? Can anyone out there say their contact database is completely accurate with only correct addresses? You don’t know who opens the envelope and who handles that piece of paper along the step from envelope to chart. There is no audit trail to ensure authorized individuals only viewed the PHI.

All this trouble yet US Mail seems to remain as the leading form of communication in use today for the exchange of medical information. We can do better.

The Phone – You call the patient/physician directly and share PHI with the individual on the other end of the phone. This method seems a bit more secure, as long as you verify the identity of the individual on the other end of the line, make sure they are not using a speaker phone, and that no unauthorized individuals are within earshot of the call.

Here’s what you don’t know. You don’t know if that call is being intercepted. Is the call placed on a cordless phone? If so, someone with a simple radio receiver could be listening to your conversation. If a cell phone is being used, you may have the same problem. What if the person is not there? Heaven forbid you leave a message on a voicemail box or answering machine for anyone to hear.

While the phone seems to be a better solution for exchange of PHI, it requires both parties be willing and available at the same time in order for the transfer to take place. Ultimately, this proves to be the biggest problem with the phone approach.

FAX – The FAX machine was invented in the mid-80s and quickly dominated the business landscape. The ability to instantly transfer documents to locations around the world has great appeal and it seems like a natural fit for exchanging PHI. Simply place a document on the FAX machine, dial the number, and hit send. Instantly, the information is sent to the hands of the intended recipient and everyone is happy.

Here’s what you don’t know. You don’t know for sure if the number you dialed was the correct number. Yes, you can get a confirmation page, but you have to request and review the confirmation page and if that confirmation comes back with the wrong name, you cannot recall the FAX you just sent. The damage is done. With the explosion of mobile devices, phone numbers are changing constantly and having the correct FAX number is a bigger nightmare every day. Can anyone honestly say their contact phone numbers are 100% accurate?
You also don’t know if anyone is standing at the FAX machine when the document is being sent. Yes, you are supposed to know, but who really takes the time to confirm the correct individual is standing by the correct machine at the correct time?

These are the three standard and accepted forms of communication for PHI and all three of them have serious security concerns for patients and providers. To be more secure, all three require more resources. Mail can be registered. Phone call can be planned and scheduled to ensure security. FAX messages can be scheduled, tested, and confirmed. All of these measures have significant cost increases for healthcare organizations. What else is there and is it better?

Internet Communications – You make PHI available via a secure web site, require users to be authenticated, encrypt the transfer of information, log every instance of PHI access with unique user, date, time, location, IP address, operating system, web browser, etc., and run audits periodically to ensure security is maintained. If done right, this form of communication is far and away the MOST secure and cost effective way to exchange data.

Here’s what you DO know – You know who logged in, when, how long, from where, and exactly what they viewed. You know communication was encrypted and could not be intercepted during the coarse of the transaction. You have the added ability to limit or end access to PHI on a per user basis if a patient decides to stop communications with a given provider.

You have also provided access to information outside of the demands for a scheduled information exchange time. You can send records to individuals on the opposite side of the globe and do it during regular business hours. You are falling in line with other industries who recognize the power of Internet transactions such as banks, retailers, and everyone else doing business in the world.

Are there any risks with Internet access to PHI? Of course there are. My qualifying statement was, “if done right.” There are HIT professionals who can design and build systems that accomplish all the security goals for electronic PHI exchange. Those individuals need to be engaged in the design and deployment of any electronic system. You also need to engage information security professionals.

There is also the issue with forgetting passwords or sharing passwords. Both of those ultimately fall on the end user, but a well-designed system would minimize the “forgots” and eliminate the sharing.

The only true secure way to exchange PHI is in-person face-to-face. After that, using a web-based secure system is the ONLY way to go.

myMDAnderson for Physicians – Expanding Access and Improving Communication

The M. D. Anderson Cancer Center’s physician web portal, myMDAnderson for Physicians, (https://my.mdanderson.org) has been providing improved access to patient information and streamlined communication to non-M. D. Anderson physicians since 2005. While the site has been a major step forward, access to the complete medical records for a patient has been lacking. To complete the continuum of patient care and strengthen the relationship between M. D. Anderson and their community physician partners, M. D. Anderson will soon unveil an improved version of myMDAnderson; providing access to nearly the entire patient medical record.

Physician portals range in scope and effectiveness; form “post card” sites to those who exchange medical information. I’ve seen examples of physician referral request systems that amount to little more than providing the ability for users to suggest when their patients may want an appointment. While this is certainly an improvement from phone-based systems, it still leaves a lot to be desired. myMDAnderson for Physicians has set the standard for physician portals and this new level of access will continue to raise the bar.

If you are a licensed, practicing physician and have patients being treated or want to refer a patient to M. D. Anderson, go to myMDAnderson for Physicians and register today.

HIMSS 2009 Conference Wrap Up

HIMSS09 Banner

The HIMSS 2009 Annual Conference and Exhibition is over for another year. This year’s theme, “Architects of Change” proved to be a central focus for the majority of educational sessions I attended. With tight economic conditions facing many of us, the pressure to deliver quality and valuable content has never been higher and this year’s conference delivered.

In my post, HIMSS 2009 – What Do I Expect to See, I outlined two concepts I was hoping for; a maturing of HIT and a wealth of good ideas, success stories, and a peer group of committed HIT. Did HIMSS09 Deliver on my expectations? Yes, and then some.

To begin, the community aspect of this year’s HIMSS was unlike any prior year thanks to the addition of Social Media; especially Twitter. Thanks to HIMSS09, I wound-up adding over 40 people to my Twitter following (@timjedwards) and exchanged information with even more. Twitter added a dimension to the conference that was not available before, first-hand live reporting of sessions and events from multiple perspectives. Twitter not only helped connect people, it helped to document the events for everyone to share. I recommend reviewing #himss09 hash tag to see what I mean. Add to that my participation in the official “Meet the Bloggers” session and the growth of that peer group could not have gone better.

With the peer group can a wealth of good ideas, success stories, and metrics. The education sessions this year focused more on outcomes than ever before. In all three of my daily wrap ups (Sunday, Monday, and Tuesday) I found sessions that focused on actual results and success stories from the integration of HIT. It was in these stories and examples the maturing of HIT I was after; the realization that outcomes needs to be the driving force in all IT implementation. HIT has to be used to improve patient outcomes and streamline operations, not for technologies sake.

I want to thank HIMSS for the integration and recognition of Social Medial in the enhancement of the conference activities and for providing quality conferences that justify both the time and expense of attending. I look forward to next year and hope the bar is raised again.

For more on the HIMSS09 conference, check out the following blogs:

Scenes from HIMSS09

Video: Scenes from HIMSS 09

HIMSS09 Banner

Like many of you, I had a grat time at the HIMSS 2009 annual conference in Chicago this week. While there, I managed to shot a bit of video unitl my camera ran out of battery. I was able to capture some of the events of HIMSS09 and some of the general excitement surrounding Chicago 2016 Olympic selection committee visit.

On question I heard often was, “What was the name of the group that performed at the opening keynote address?” His name is Skinny Williams (www.skinnywilliams.com) and he agreed to provide the soundtrack for this video.

Thanks to Skinny, HIMSS, and the City of Chicago for a great conference.